Éditeur(s) : HAL CCSD
Résumé : International audience
Objective Macrophages may play a significant role in the initiating stages leading to chronic inflammation/infection in cystic fibrosis (CF), via an inability to act as a suppressor cell. In a previous study demonstrating impaired function of CF macrophage, we have shown high production of soluble CD14 (sCD14). The aim of the present work is to determine origin and function of sCD14 in blood monocyte-derived macrophages from stable adult CF patients. Methods To study origin, sCD14 is measured by ELISA in supernatant of macrophages from healthy subjects (non-CF) treated with PI-PLC or cholesterol. The involvement of sCD14 in inflammation, was investigated by analysis of NF-kB and caspase 1 pathways in non-CF macrophages treated by sCD14. Measurement of gene expression was done by qPCR and proteins were quantified by ELISA and Western blot. Results Treatment with PI-PLC increased sCD14 level in the supernatant of non-CF macrophages whereas cholesterol did not modified it. Furthermore high secretion of sCD14 from CF macrophages was decreased by an inhibitor of PI-PLC. Treatment with sCD14 increased pro-IL-1β, IL-8 and TNF-α expression resulting from NF-kB activation through IkBa phosphorylation, this effect was inhibited by NF-kB inhibitors. Also, activation of caspase 1 by cleavage of pro-caspase 1 allowed the secretion of mature IL-1β, inhibited by an inhibitor of caspase 1. However, inflammasome complex involved in caspase 1 activation remains to be determined. Conclusion This data show that origin of sCD14 is partly due to the action of lipases cutting the GPI tail that serves as a membrane anchor to CD14. Furthermore sCD14 have a role in chronic inflammation in CF
the 38th European Cystic Fibrosis Conference
Vienne, Austria

hal-01162773
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01162773
DOI : 10.1016/S1569-1993(15)30203-4

Éditeur(s) : HAL CCSD
Résumé : International audience
Primary spontaneous pneumothorax (PSP) is common and affects young and active patients. Guidelines are accurate about diagnosis and treatment indications, but the initial optimal management remains unclear. Smoking is the main risk factor and smoking cessation must be systematically advised. If simple surveillance is acceptable for small PSP and/or paucisymptomatic patient with PSP, exsufflation or hospitalization with chest tube drainage remains the standard treatment in other situations. Ambulatory management is possible and could become the next standard of care. © 2015, Société de réanimation de langue française (SRLF) and Springer-Verlag France
Reanimation

hal-01326967
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01326967
DOI : 10.1007/s13546-015-1156-1

Éditeur(s) : HAL CCSD European Respiratory Society
Résumé : International audience
ISSN: 0903-1936

hal-01117958
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117958
DOI : 10.1183/09031936.00111113
PUBMED : 24687678

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
ISSN: 0761-8425

hal-01117908
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117908
DOI : 10.1016/j.rmr.2013.09.015
PUBMED : 25239580

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : National audience
INTRODUCTION:The AIRBAg study screens for bronchial obstruction in dairy farmers. We present the preliminary results after one year.METHODS:A prospective screening study based on questionnaires and electronic mini-spirometry (Néo-6(®)) that includes a representative sample of dairy farmers from the departments of Morbihan and Île-et-Vilaine in Brittany. The dairy farmers had an occupational medicine appointment and, if they demonstrated at least one marker of possible bronchial obstruction (chronic cough, chronic bronchitis, dyspnoea, wheezing, FEV1/FEV6<0.8), they were referred to a pulmonologist. The data we present here were extracted from the occupational medicine appointments because the pulmonologists' appointments are still running.RESULTS:Among the 277 dairy farmers included, 125 (45%) demonstrated "possible bronchial obstruction". The total score of the CAT questionnaire was higher in these farmers (9.1±6.2 versus 5.8±4.0; P<0.0001). In multivariate analysis markers of "possible bronchial obstruction" were eczema, manual foddering and duration of mechanical straw litter spreading.CONCLUSION:Occupational medicine appointments identified markers of "possible bronchial obstruction". We will have the complete results from AIRBAg study in 2015.
ISSN: 0761-8425

hal-01117944
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117944
DOI : 10.1016/j.rmr.2014.03.014
PUBMED : 25847201

Éditeur(s) : HAL CCSD
Résumé : International audience
Objective Oxidative stress, excess production of reactive oxygen species (ROS) and intense colonization of the respiratory tract by microorganisms are described in CF patients, leading to an influx in macrophages. This results in activation of NADPH oxidase that yields ROS, initiating the oxidative burst responsible for pathogen destruction. We showed that phagocytosis was altered in CF macrophages, yet oxidative status in this cell was not defined. The objective of this study is to draw a link between oxidative stress and plasma membrane integrity in CF macrophages, since lipid peroxidation is known to alter cell membrane. Methods Peripheral blood monocytes-derived macrophages were obtained from CF patients and healthy subjects. Plasma membrane fluidity was assessed with di4-ANEPPDHQ and oxidative status was measured with ROS indicating probes. Results In CF macrophages, membrane fluidity was increased whereas lipid peroxidation was diminished. Surprisingly, general oxidative status remained similar to the one observed in non-CF macrophages. Also, CF macrophages did not abolish chemically induced-oxidative stress. In non-CF macrophages, treatment with cholesterol slightly increased membrane fluidity whereas LPS treatment had no effect. Conclusion CF macrophages displayed an increased membrane fluidity associated with a decreased lipid peroxidation. This raises the hypothesis that membrane alteration in CF macrophages may be due to other mechanism than oxidative stress. Nevertheless, since the killing capacity of CF macrophage is defective, a deregulation of O•−2 production is very likely, suggesting alteration of NADPH oxidase or mitochondrial dysfunction
the 38th European Cystic Fibrosis Conference
Vienne, Austria

hal-01162769
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01162769
DOI : 10.1016/S1569-1993(15)30217-4

Éditeur(s) : HAL CCSD
Résumé : National audience
Nocardiosis is an infectious disease with wide range of clinical features, which can eventually lead to death. The agent responsible belongs to the genus Nocardia that includes about fifty different species. Nocardiosis occurs mainly in immunocompromised hosts. We report here three cases of disseminated nocardiosis misdiagnosed initially as cerebral metastatic lung cancer. These patients, including two immunocompetent hosts, presented with both pulmonary and cerebral lesions. In all three patients, the diagnosis was based on magnetic resonance imaging with diffusion sequence, apparent diffusion coefficient reconstruction and neurosurgical cerebral biopsies. Treatment with an appropriate antibiotic regimen was prolonged for several months. Progress was favorable with full resolution of the neurological symptoms and the radiological abnormalities. These three cases emphasize the diagnostic challenge of nocardiosis, especially in disseminated disease.
Revue Des Maladies Respiratoires

hal-01659440
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01659440
DOI : 10.1016/j.rmr.2017.08.002
PUBMED : 28918971

Éditeur(s) : HAL CCSD European Respiratory Society
Résumé : International audience
[No abstract available]
ISSN: 0903-1936

hal-01406071
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01406071
DOI : 10.1183/13993003.00252-2016
PUBMED : 27799394

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Parapneumonic pleural effusions represent the main cause of pleural infections. Their incidence is constantly increasing. Although by definition they are considered to be a “parapneumonic” phenomenon, the microbial epidemiology of these effusions differs from pneumonia with a higher prevalence of anaerobic bacteria. The first thoracentesis is the most important diagnostic stage because it allows for a distinction between complicated and non-complicated parapneumonic effusions. Only complicated parapneumonic effusions need to be drained. Therapeutic evacuation modalities include repeated therapeutic thoracentesis, chest tube drainage or thoracic surgery. The choice of the first-line evacuation treatment is still controversial and there are few prospective controlled studies. The effectiveness of fibrinolytic agents is not established except when they are combined with DNase. Antibiotics are mandatory; they should be initiated as quickly as possible and should be active against anaerobic bacteria except for in the context of pneumococcal infections. There are few data on the use of chest physiotherapy, which remains widely used. Mortality is still high and is influenced by underlying comorbidities.
Les épanchements pleuraux parapneumoniques représentent la principale étiologie des pleurésies infectieuses. Leur incidence est en constante augmentation. Bien qu’ils soient qualifiés de « parapneumoniques », l’épidémiologie microbienne est différente de celle des pneumonies avec notamment une plus grande fréquence des germes anaérobies. La ponction pleurale exploratrice représente l’étape diagnostique centrale qui permet de distinguer les épanchements parapneumoniques compliqués et non compliqués. Seuls les épanchements parapneumoniques compliqués doivent faire l’objet d’un traitement évacuateur reposant sur la mise en œuvre de ponctions pleurales répétées (PPR), d’un drainage thoracique ou d’une prise en charge chirurgicale. Le choix de la technique évacuatrice première reste débattu car il existe peu d’études prospectives comparatives. L’utilisation d’agents fibrinolytiques n’a pas fait la preuve de son efficacité sauf lorsqu’ils sont utilisés en association à la DNAse. L’antibiothérapie doit être systématique, précoce et couvrir les germes anaérobies, sauf en cas d’infection à pneumocoque. Il existe peu de données sur la place de la kinésithérapie qui reste largement utilisée. La mortalité est élevée et directement influencée par les comorbidités sous-jacentes.
ISSN: 0761-8425

hal-01117905
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01117905/file/Les%20%C3%A9panchements%20pleuraux%20parapneumoniques_accepted.pdf
DOI : 10.1016/j.rmr.2014.12.001

Éditeur(s) : HAL CCSD
Résumé : International audience
L’asthme chez les agriculteurs est un phénomène contradictoire, puisque le milieu agricole est à la fois décrit comme étant à risque d’asthme inflammatoire et comme étant protecteur d’asthme allergique.Une étude ancillaire d’AIRBAg (Analyse Incidence et facteurs de Risque de BPCO Agricole) a permis l’analyse de 603 agriculteurs laitiers d’Ille et Vilaine et du Morbihan, afin de définir la prévalence de l’asthme dans cette population, et d’identifier des facteurs de risque et/ou protecteurs de la maladie asthmatique. Pour cela, les patients asthmatiques ont été comparés au reste de la population agricole selon des critères cliniques, professionnels et environnementaux.Nous avons mis en évidence une prévalence de 6 % d’asthme. Aucun facteur professionnel n’était significativement associé au risque d’être asthmatique. Il semble que les facteurs protecteurs principaux soient pour la plupart retrouvés dans notre population d’asthmatique, hormis l’allaitement maternel, présent chez seulement un quart des patients.La prévalence de l’asthme dans notre cohorte d’agriculteur est donc semblable à celle de la population générale, et l’asthme est la maladie obstructive la plus fréquente dans l’échantillon. Aucun facteur professionnel n’a été identifié comme facteur de risque.
Revue des Maladies Respiratoires
Lille, France

hal-01122830
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01122830
DOI : 10.1016/j.rmr.2014.10.695

Éditeur(s) : HAL CCSD Springer Verlag
Résumé : International audience
Bronchoalveolar lavage (BAL) is a major diagnostic tool in lung diseases, including viral respiratory infections. We aimed to better define the situations where viral tests should be performed on BAL fluid (BALF). We retrospectively studied all cases where viral tests [immunofluorescence, immunocytochemistry, viral culture, and/or polymerase chain reaction (PCR)] were performed on BALF during a period of 1 year (2008) in our institution. We compared the characteristics of patients with virus-positive versus virus-negative BALF. Of the 636 BALF samples sent to the microbiology laboratory, 232 underwent viral tests. Of these, 70 (30 %) were positive and identified 85 viruses: herpes simplex virus (HSV)-1 (n = 27), cytomegalovirus (CMV, n = 23), Epstein-Barr virus (EBV, n = 18), human herpesvirus (HHV)-6 (n = 12), respiratory syncytial virus (RSV, n = 3), rhinovirus (n = 1), and adenovirus (n = 1). The variables associated with positive viral tests on univariate analysis were immunosuppression [human immunodeficiency virus (HIV), corticosteroids >10 mg/day for ≥3 weeks, or other immunosuppressive therapy], ground-glass attenuations on computed tomography (CT) scanning, late-onset ventilator-associated pneumonia (VAP), and durations of (i) hospital stay, (ii) intensive care unit (ICU) stay, and (iii) mechanical ventilation before BAL (p < 0.01 for each comparison). On multivariate analysis, only immunosuppression [odds ratio (OR) 6.4, 95 % confidence interval (CI) [2.8-14.3], p < 0.0001] and ground-glass attenuations (OR 3.7, 95 % CI [1.8-7.7], p = 0.0004) remained associated with virus-positive BAL. None of the viral tests performed on BALF for the initial assessment of diffuse infiltrative lung disease (n = 15) was positive. PCR improved the diagnostic yield of viral tests on BALF by 50 %. Testing for viruses on BALF should be mostly restricted to immunocompromised patients with acute respiratory diseases and/or patients with unexplained ground-glass attenuations on CT scanning.
ISSN: 0934-9723

hal-00873158
https://hal.archives-ouvertes.fr/hal-00873158
DOI : 10.1007/s10096-012-1791-7
PUBMED : 23238685

Éditeur(s) : HAL CCSD
Résumé : International audience
INTRODUCTION: There are no French guidelines for the management of complicated parapneumonic effusions. A national observational study was carried out to assess the main features of current clinical practice for this condition. MATERIAL AND METHODS: A questionnaire was sent by email to the 1500 members of the Société de Pneumologie de Langue Française (SPLF) between 15th November and 15th December 2012. RESULTS: There were 92 responders, i.e. a response rate of 6%. Of these, 87 physicians mentioned that they were involved in the management of patients with complicated parapneumonic effusions with a median number of cases of 10 per year (IQR: 5-20). Chest tube drainage was the main approach used for pleural fluid aspiration (n=51/87), followed by repeated thoracentesis (n=29/87) and early surgery (1/87). Five physicians answered both chest tube drainage or repeated thoracentesis and one physician either chest tube drainage or early surgery. Pleural fibrinolytics were never used by 20% of physicians, only in case of loculations by 70% and by 10% of respondents in all cases. Only 3 physicians combined fibrinolytics with DNAse. A double antibiotic dose was used by one third of physicians. All the physicians used respiratory physiotherapy during hospitalization and to aid recovery. Follow-up practices were heterogeneous. CONCLUSIONS: The management of complicated parapneumonic effusions varies significantly in France. National guidelines may be helpful to define best practice and aid in its implementation.
Revue Des Maladies Respiratoires

hal-01146851
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01146851
DOI : 10.1016/j.rmr.2015.01.001
PUBMED : 25725981

Éditeur(s) : HAL CCSD
Résumé : International audience
Journal of Cystic Fibrosis
Dublin, Ireland

hal-01122611
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01122611
DOI : 10.1016/S1569-1993(12)60121-0

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
Objectifs Aucun consensus n’existe concernant la prise en charge des pneumothorax spontanés de grande abondance. Les recommandations actuelles proposent soit une exsufflation à l’aiguille, soit un drainage thoracique, la plupart des patients étant hospitalisés. Nous avons voulu tester l’efficacité d’une prise en charge ambulatoire des pneumothorax par cathéters de petit calibre dit en « queue de cochon ». Méthodes De février 2007 à janvier 2011, tous les pneumothorax spontanés primaires et secondaires de grande abondance reçus à l’hôpital de Lorient ont été pris en charge par drainage via un cathéter de petit calibre associé à une valve anti-retour. Les patients rentraient immédiatement à domicile et étaient par la suite évalués tous les deux jours selon un algorithme précis. Résultats Sur 132 pneumothorax consécutifs (110 spontanés primaires, 22 secondaires), 103 ont été exclusivement traités en ambulatoire avec un retour complet à la paroi thoracique à j2 ou j4, ce qui représente un succès de l’ambulatoire à 78 %. La durée moyenne de drainage était de 3,4 jours. Sept patients ont été initialement hospitalisés, mais sont rapidement rentrés à domicile et ont été totalement guéris à j2 ou j4, ramenant le taux de succès à 83 %. L’usage d’antalgique était faible. Le taux de récidive à un an était de 26 %. En cas de succès, cette prise en charge est potentiellement économique avec un coût moyen estimé à 926 comprenant 2 consultations et une radiographie thoracique, en comparaison aux 4276 estimés si le patient était hospitalisé avec mise en place d’un drain thoracique pendant 4 jours. Conclusion La prise en charge ambulatoire des pneumothorax spontanés de grande abondance par cathéters de type « queue de cochon » associés à une valve anti-retour peut être considérée comme un traitement de première intention raisonnable. En comparaison avec d’autres études, notre protocole ne nécessite pas d’hospitalisation et est économique
ISSN: 0761-8425

hal-01163246
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01163246
DOI : 10.1016/j.rmr.2015.04.019

Éditeur(s) : HAL CCSD Elsevier Masson
Résumé : International audience
o abstract
ISSN: 0761-8425

hal-01187123
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01187123
DOI : 10.1016/j.rmr.2015.06.015